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Medicare is the federal health insurance program for people 65 or older, recipients of Social Security Disability Insurance benefits, and those with End-Stage Renal Disease. Types of Medicare coverage are organized into different “parts”:
• Part A is hospital insurance and covers hospital stays, hospice care, and skilled nursing care a person may need to rehabilitate after being hospitalized.
• Part B is medical insurance and covers doctor visits, lab tests, diagnostic screenings, medical equipment, ambulance transportation, and other outpatient services.
• Part C is another name for Medicare Advantage. Part C is managed by private insurance companies and bundles together services covered by Part A and B with extra benefits.
• Part D pays for some prescription drugs and is also managed by private insurance companies.
What if I need skilled nursing care after a hospitalization?
Medicare has suspended the 3 hospital overnights requirement. Beneficiaries who have recently used all their skilled nursing days can also ask for more days without having to start a new benefit period.
What if my durable medical equipment has been lost or damaged?
Durable medical equipment providers have the flexibility to waive replacement requirements. This means the face-to-face requirement, a new doctor’s order, and a new medical necessity documentation is not required.
Medicare denied payment – what can I do?
If you disagree with a coverage or payment decision, you can appeal. Your deadline for filing an appeal depends on which part of Medicare (A, B, C, or D) you are appealing. Currently, appeal deadlines for Medicare Advantage (Part C), fee-for-service (Part C), and Part D have been extended. Medicare will also process appeal requests using the information available even if it does not meet all the requirements.
Be aware of scammers – guard your Medicare card and number just like you would a credit card. Check Medicare claims summary forms for mistakes. Do not give your Medicare number to anyone calling you over the telephone.
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What am I responsible for paying during the emergency declaration?
Starting in March 2020, the federal government declared a public health emergency and required Iowa Medicaid to take certain measures to protect Medicaid recipients. These measures include waiving monthly premiums, expanding access to certain services, and continuing coverage for those in the program even if their income changes. It is expected that these protections will end, possibly as soon as fall 2022, but when exactly is unknown. Once the federal government ends the public health emergency, Iowa DHS will begin its wind down plan and go back to its normal eligibility process. You can read more about the wind down plan here.
Individuals who are receiving facility care are still responsible for paying their client participation amount.
There is no cost for Medicaid recipients who get COVID-19 testing or COVID-19 vaccines. Medicaid will also cover telehealth services. Out-of-network doctors will be covered when medically necessary. Prior authorization for COVID-19 testing is not required and there are no limits on medically necessary treatment for COVID-19. You may also be able to fill your prescriptions for an extended period of time.
Will my Medicaid coverage continue?
DHS has temporarily paused all terminations for medical assistance programs until the emergency declaration has ended. Medicaid members may still be moved from one Medicaid program to another. “Healthy behavior” requirements under the Dental Wellness Program are suspended. Children who age out of Hawki will be automatically enrolled in Iowa Health and Wellness.
How is facility Medicaid coverage effected?
For those who currently receive facility Medicaid, DHS will not disenroll you if you have not spent down your resources to under the $2,000 resource limit. However, any new applicants still have to meet all income and eligibility requirements before they are eligible. Client participation for facility care and PACE is not waived and participants need to continue making those monthly payments.
How are Medicaid waiver services affected?
DHS is allowing a parent, legal guardian, or immediate family member to provide Home and Community Based Services (HCBS) for the duration of the COVID 19 emergency. Members should work with their case managers on any changes that need to be made to their service plans. If a “shelter in place” order is issued, HCBS staff are considered essential workers and would be able to continue providing care. DHS will continue to process new HCBS applications, but with some changes. interRAI, the provider who does the in-person evaluations as part of the application process, has issued guidance about performing these assessments through live video stream.
How will my immigration status be affected if I use Medicaid to get treatment for COVID-19?
U.S. Citizenship and Immigration Services (USCIS) has said that it will not consider “testing, treatment, or preventative (including vaccines, if a vaccine becomes available)” related to COVID 19) in any Public Charge determinations. This guidance applies to immigrants applying for lawful permanent resident status (green card), extension of stay, or change of immigration status.
More Information on Insurance Coverage of COVID-19 Testing
- There is free testing through the state of Iowa: https://www.testiowa.com/en
- The federal Families First Coronavirus Response Act and the CARES Act provide for COVID-19 testing without cost-sharing or prior authorization.
- No co-pays for Medicaid COVID-19 testing.
- No out of pocket costs for Medicare COVID-19 testing https://www.medicare.gov/coverage/coronavirus-test
- Several Iowa health insurance companies have announced that they will waive cost-sharing for COVID-19 testing
Food Assistance (SNAP)
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DHS received permission from the federal government to increase SNAP benefits from April 2020 through March 2022. The increase in SNAP benefits that was in place for the first two years of the pandemic ended in April 2022. SNAP benefits are now back to pre-pandemic levels. You can view more information about SNAP benefits on the DHS website here.
Iowa Legal Aid provides help to low-income Iowans.
To apply for help from Iowa Legal Aid:
- Call 800-532-1275.
- Iowans age 60 and over, call 800-992-8161.
- Apply online at iowalegalaid.org
If Iowa Legal Aid cannot help, look for an attorney on “Find A Lawyer” on the Iowa State Bar Association website iowabar.org. A private attorney there can talk with you for a fee of $25 for 30 minutes of legal advice.
As you read this information, remember this article is not a substitute for legal advice.